Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Enterobiasis (Pinworm) 531

■Other worms that may emerge: occasionally trichuris (whipworm),

which is 3 to 5 cm long

management

What to Do First

■Assess other family members for infestation (or can treat all members

empirically).

General Measures

■Teach good hygiene, such as hand washing after defecation, wash-

ing of clothes and pajamas, trimming fingernails, vacuuming. These

measures help prevent reinfection.

specific therapy

Indications

■Treat symptomatic patients, and most asymptomatic ones since they

can infect others (though their own health is not impaired). In a

household, test all children or treat them presumptively.

Treatment Options

■Mebendazole, repeat in 2 weeks (treatment of choice)

➣pyrantel pamoate, repeat in 2 weeks

➣albendazole, repeat in 2 weeks for patients >2 yo

Side Effects & Complications

■Rare. All 3 drugs may cause mild intestinal symptoms in small minor-

ity, and pyrantel pamoate rarely causes headache, dizziness, or rash.

■Contraindications to treatment: absolute: none

■Contraindications to treatment: relative: asymptomatic adult not

with children

follow-up

Routine

■No tests necessary after treatment. If symptoms or visible worms

return, retreat entire household and enforce general hygienic mea-

sures.

complications and prognosis

■If eggs or worms get into fallopian tubes or appendix, abdominal pain

and tenderness can occur and mimic other conditions, like appen-

dicitis. Complications from intestinal disease are nil. Prognosis is

good.